Working Paper: NBER ID: w31825
Authors: Joan Costafont; Sergi Jimenez-Martin; Cristina Vilaplana-Prieto; Anala Viola
Abstract: Spain together with Scotland are two countries that exhibit the largest expansions in long term care (LTC) in the last two decades, universalizing subsidies and supports. This paper is part of a global effort to provide a snapshot of the trends in LTC use and access, as well as the financing, and organization of the LTC system compared to other higher-income countries. The passage of Act 39/2006 on the Promotion of Personal Autonomy and Care for Dependent Persons (SAAD in Spanish) on December 14th, 2006, universalized coverage for care subsidies and supports, allowing access to care conditioned only on individuals’ assessment of care needs. As a consequence, LTC spending as a percentage of GDP has risen from 0.5% in 2003 to nearly 0.9% in 2019, despite private LTC insurance playing a minor role. Still today, LTC remains heavily reliant on informal care, which is now partially subsidized by a caregiving subsidy as part of SAAD. Long-term care spending in Spain amounts to between 1.27% (conservative estimates) and 1.70% (flexible estimation) of GDP. Finally, the system reveals significant gender imbalances in the provision of care, with women accounting for most caregivers in both formal (87%) and informal (58%) care.
Keywords: long-term care; Spain; SAAD; aging population
JEL Codes: D14; G22; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| SAAD reform (E69) | universalized access to LTC services (G52) |
| SAAD reform (E69) | LTC spending as a percentage of GDP (E20) |
| SAAD reform (E69) | access to care based on individual assessments (I11) |
| SAAD reform (E69) | informal caregiving dynamics (D13) |
| austerity cuts in 2012 (H69) | reduced generosity of benefits (H55) |
| austerity cuts in 2012 (H69) | delayed access for moderate dependency individuals (I12) |